Pain Is Not a Symptom of PCOS

PCOS painPain can be the symptom of several different gynecological conditions including endometriosis, adenomyosis, and ovarian cysts.

Pain is not a symptom of the hormonal condition PCOS.

But what if you have pain and your doctor discovers polycystic ovaries on ultrasound? Surely, that offers some kind of explanation? Nope. Your pain is not related to that ultrasound finding.

Here are three things to understand.

Polycystic ovaries are not ovarian cysts

Polycystic ovaries are follicles or eggs, which are normal for the ovaries.

You have more eggs when you’re younger, so you’re quite likely to have “polycystic ovaries” when you’re younger. It really just means “many eggs.”

Having polycystic ovaries doesn’t mean you have the hormonal condition PCOS. It actually does not mean anything at all.

Polycystic ovaries can show up on an ultrasound when:

  • you’re perfectly normal
  • you have PCOS
  • you have hypothalamic amenorrhea,
  • you have endometriosis, or adenomyosis, or any number of other issues that are the actual cause of pain.

There is such a thing as ovarian cysts that are abnormal structures and can burst and cause pain. Ovarian cysts are not polycystic ovaries.

PCOS (polycystic ovary syndrome) is a hormonal condition, not a gynecological one

PCOS is a hormonal condition that is having too many androgens or male hormones. In fact, it’s best defined as the condition of androgen excess when all other causes of androgen excess have been ruled out.

If you have PCOS, then you need to lower androgens. That’s what metformin and a no-sugar diet can do but only if you have the classic insulin-resistant type of PCOS. Those treatments will do nothing for pain.

For more information about how to diagnose and treat PCOS, see Chapter 7 of Period Repair Manual and Treatment for 4 Types of PCOS.

You can have both PCOS and pain but they’re separate issues

PCOS is common. But so is period pain and so the conditions that can cause pain such as ovarian cysts and endometriosis.

It is possible to have both PCOS and period pain.

If your pain is mild, then it should respond to the simple treatments discussed in my period pain post.

If your pain is severe, then see your doctor. You might have endometriosis. Read When Period Pain Is Not Normal and What If You Have Both PCOS and Endometriosis?

Finally, yes. The pill can suppress the symptoms of both PCOS and period pain, but cannot fix either problem.

Share your story.

Dr Lara Briden

41 thoughts on “Pain Is Not a Symptom of PCOS”

  1. I have PCOS and have had a cyst rupture multiple times and have been hospitalized. I had internal bleeding and emergency surgery. So if not a cyst what ruptured then., I have had it since I was 17 and am now 27,don’t tell me its not painfull. If your not a OBGYN or have never had PCOS you have no idea what you are talking about. Cysts form in the egg folicals when you don’t ovulate.Some women who suffer from this have pain until a cyst ruptures then they have relief. Others, like me are always in pain and that pain increases when I have a rupture to the point I cannot sit or stand and have to be rushed to the emergency room. Pcos is a hormonal condition that causes multiple cyst to form in ovarian folicals when ovulation does not happen. I have had about 2-3 transvaginal ultrasounds a year since I was 17. The pain I feel changes throught the month but its almost always present.

    • as I explain in the blog post, it’s possible to have both ovarian cysts (the kind that rupture) and the hormonal condition PCOS.
      But “polycystic ovaries” are not ovarian cysts.

  2. I have pcos… I was told that i have polycystic ovaries… And i am in pain everyday… They said polycystic ovaries not ovarian cyst…. Okay.. So u say it doesnt cause pain. When you dont ovulate.. It creates the follicles to stay and attach to the ovaries after so long it keeps building causing your ovaries to become enlarged…. So ur saying that and enlarged overies wouldnt be painful? If u catch pcos at the very beginning no u wont have pain… But its hard to find u have pcos until u start showing symptoms such as hair growth weight gain and .. Wait for it… Pelvic pain. This is the kind of articles that scare women into thinking they have cancer or start over thinking there symptoms… I have a specialist in endometriosis she has studied this for yearrrrs and told me that yes pcos can be painful. The cyst themselves may not but that’s not the only thing that happens. The cyst cause ur ovaries to become enlarged. Enlarged ovaries are a symptom of pcos.. And it is painful. Please do more research on a condition before writing articles when u clearly dont fully understand what u are talking about.

  3. Pain isn’t a symptom? Clearly, you don’t have PCOS and have absolutely no clue what you are talking about. Maybe if you have no idea what it actually feels like to live with this condition you shouldn’t be writing articles on the internet about things you know nothing about. Seriously!
    Walk one month in my shoes and tell me pain isn’t a symptom! Women without PCOS, without cysts and that have normal cycles have absolutely no clue what it’s like, what it feels like or how debilitating the pain can truly be.

    • Ovarian cysts can cause pain, but polycystic ovaries are not ovarian cysts.
      And the hormonal condition PCOS does not include ovarian cysts or pain as a symptom.
      All that said, it is possible to have pain AND the hormonal condition PCOS. But the pain is a separate issue.

  4. I do not have pcos. I had a history of mucinous cyst in ovary which was operated 6 years back. Right now i have regular periods, regular bleeding etc. But at times my periods are painful. Could you please advice what could be the reason.

  5. I have PCOS, once experienced severe pain in my right ovary. I remember seeing a student doctor and he kind of scoffed at my thinking it was my ovary, proved him wrong though when an ultrasound revealed that a ruptured cyst had burst a blood vessel and I was bleeding internally. It was only minor bleeding, but it explained the pain, has happened twice since being diagnosed – currently my PCOS is not ‘active’ as I’m on a ketogenic diet.

    • Thanks for sharing your story. Just to clarify: Ovarian cysts can cause pain (especially if they rupture), but ovarian cysts are not the same thing as the hormonal condition polycystic ovarian syndrome.

  6. Hi Laura,

    I recently purchased your Period Repair Manual and really enjoy it! Thanks for putting all your time and effort into a manual to help so many of us that struggle with our health.

    I have PCOS and already don’t eat any gluten and skip dairy most of the time. I do however miss whey protein options for shakes and bars when traveling. Does whey cause inflammation as well for PCOS patients?

    Thank you!

  7. Hello Lara, please pleaseeee reply, I am having awful days:

    I am a 24-year-old virgin girl from Iran, and I’ve been diagnosed with PCOS since I was 15. For 7 years, I consumed “birth control” pills, which I finally thought might be a risk, so I stopped and asked my doctor to really do something about it!

    The surprising part is even after stopping the pills, no symptoms that are regular for women with PCOS ever happened to me. I am 45 Kilograms, I work out regularly (a big fan of TRX!) I have no acne, no abnormal facial hair (any masculine kind of hair in any part of my body), estrogen, progesterone, testosterone levels are all normal according to my tests. Prolactin level is normal. FSH, TSH levels are normal. Everything is literally normal “EXCEPT” LH which is a little bit high, and THE MOST ANNOYING PART: I don’t get period…

    Although my hormone levels are normal, doctor gave me doses of progesterone (oral and injection) for 3 months in order to get my period back, but nothing happened. Doctor added metformin, still nothing happened at all!

    Finally, doctor decided to combine estrogen and progesterone pills. which means: “21 tablets of conjugated estrogens + 20 tablets of medroxyprogesterone for the last 10 days + metformin” every month, which finally helped me get my period back (but only if I use them regularly every month).

    But this is driving me really crazy.
    Since my symptoms are totally different from the ones that are expected, how can I really stop the PCOS?! I’m not even sure what type it is!
    I am stressed that I might even have issues later if I ever decide to get pregnant in my 30s.

    I know this was really long and my English may not be good, but I do really wish you notice my comment,and reply.

  8. Hi Lara,
    after how many months of not ovulating would you suggest inducing a period, and how should you do this? I’m currently at 5 months and although I’ve learned that the missing ovulations are worse than the missing periods, I’m a little bit concerned about the long time with no bleeding… Also, can you suggest a list of hormones to check that I can give to my doctor because we aren’t getting behind the cause of my lack of ovulations (besides the elevated testosterone). I would really appreciate this.

  9. Hello Lara,
    I have been reading your blog for some years and have found it helpful and fascinating. I have been diagnosed with PCOS and have successfully been treating it by adhering to your gluten free, A2 diary, and refined sugar free diet. Because of this, I now have periods every 25/26 days and am at a normal weight. I am TTC and it doesn’t seem to be working. I have been using the ovulation predictors and they are not spiking for me, but I do have a regular bleed and my cervical mucus indicates ovulation. What would you guess might be an underlying cause? Is my LH not spiking or am I not ovulating? I do have a high stress job (teaching high schoolers) and my blood pressure is elevated during the school year.

    • A better way to detect ovulation is to track your temperatures. Have you tried that?
      And if you are ovulating, your next step is for your partner to have a sperm test. (And when you get his result, please look closely at the parameters including “sperm morphology.”) If you’re ovulating but not managing to conceive, there’s more than a 50% chance that it’s a male issue.

  10. Hi Lara, I’ve been vegan my whole life and get regular periods! I messaged you on Instagram, looking forward to hearing from you.

  11. What do you think about taking cortisone against elevated testosterone? I have very long and irregular cycles (and I’ve always had) but I have no other health problems. My doctor checked everything and I only have slightly too much testosterone, everything else is fine. Also, I was able to rule out every possible cause of PCOS that you wrote about in your book (because I thought that I might have PCOS, but I’m not so sure anymore).
    My doctor suggested I could take the pill or just do nothing, but I have read that cortisone could be another option. Do you know something about this treatment?

    I’d be so happy if you could answer this. Many thanks

      • It’s my testosterone that is high, I don’t think she said anything about my adrenal hormones so I think they are normal. So that means cortisone wouldn’t be the right treatment?

        She didn’t test insuline but I took myo-Inositol for 6 months and ate almost no sugar during this time (only whole fruits) but I didn’t see any results which is why I assume I can’t have insulin resistance.

  12. Hi Lara!

    I have recently come across your blog and read your new book and I just wanted to say thank you so much for all of the wonderful in depth research and time you have put into this topic. All of the information has been so helpful and eye opening for me as I have recently come off of the birth control pill after 10 years of use. I have only been off the pill for 3 months and have had extremely regular cycles (28-29 days) but seem to be suffering from really delayed ovulation and short luteal phase as confirmed by temperature and OPK tests. Do you see this a lot and think my body just needs more time to adjust? Or do you think a supplement like magnesium or zinc like you commonly recommend would help? Any response or thought would be greatly appreciated!

    Thanks so much again for providing so much information on a topic that is so important to women!ra

    • Hi Rachel, Thanks for your feedback about my book. It’s still early days and I expect your luteal phase will improve. Especially if you’re healthy and fully nourished and younger than 40.

  13. “This article is worth reading for every woman as we have been hearing so much about PCO’s these days. The way you have comprehended it and cleared the related doubts I am sure it will bring peace to most of the affected and confused readers. Well done..!!

  14. I was determined to have PCOS (polycystic ovarian syndrome) in the wake of endeavoring to consider for over a year. I was put on metformin which made me unpleasantly sick all the ideal opportunity for an entire year and still did not ovulate which implied despite everything I couldn’t imagine. I did a huge amount of research and began discovering little approaches to attempt and adjust my hormones normally, without prescription.

  15. I was diagnosed with PCOS after trying to conceive for over a year. I was put on Metformin (which made me horrible nauseous ALL THE TIME) for a full year and still did not ovulate which meant I still could not conceive. I did a ton of research and started finding little ways to try and balance my hormones naturally, without medication. I am just now starting a trial of the herb Tribulus (found within this article here: https://www.drlam.com/blog/pcos-natural-treatment/29523/) to try and help, no luck yet, but fingers crossed!

    Any thoughts on having a “Enlarged Ovaries” ?. This is what they found on my ultrasound- surprisingly no cysts (still unclear why its called poly-cystic). Doctor said it didn’t mean much except maybe my body could be producing excessive hormones- which I did have the common high testosterone.

    Thanks in advance for any further info you may have!!

  16. I am currently awaiting a Gynaecology appointment as a cyst was detected on my left ovary (second time a cyst has shown on a scan). I had my left tube removed due to a ruptured ectopic (3 years ago) and ever since then I have been really struggling with irregular periods, depression, bad skin, flaky/itchy scalp, tiredness etc. (I could go on) when I never had any of these issues before. I also have months where on the first day, or the day before, of my period I have excruciating abdominal pain and sickness, where pain killers don’t help to relive the pain. I have informed doctors of the symptoms and the pains but am told to wait until I am seen by the hospital.
    My worry is that I get to the hospital, have tests, and nothing is detected. Could this be possible? I personally think that the issues I have are when I ovulate (or try to) on the left side, which causes the cyst and symptoms. I am a little worried that if I ovulate on my right and have none of the above, then nothing will show up to help me.

  17. Thanks for this, I fit into this category of someone who was ‘diagnosed’ with PCOS at a young age but it doesn’t seem to be an accurate description anymore.

    I have regular periods, but in the last 6 months have started spotting on day 10-11 of my cycle. I ovulate usually at day 17 so I don’t think it’s ovulation spotting. I’m not sure what this could be related to, as there seems to be a lot of information about spotting in the luteal phase but not the follicular phase?

      • I have spoken to a doctor who offered the pill as a solution. I had a pelvic ultrasound recently which was all clear, and my hormone tests seem to be mostly normal except low progesterone, so I’m not sure what it could be.

  18. Hi Lara, my zinc levels haven’t increased despite constant supplementation. I have been taking 30mg for more than 2 years. My zinc levels are still low. I don’t eat much phytic acid so that shouldn’t be obsurring absorption. Any ideas?

        • First of all, are you measuring serum zinc? It’s not a terribly reliable test and can be affected by many things such as whether you were fasting or not. (Zinc is higher after a fasting test because of zinc released by the muscle tissue.) Also, it really only reflects your current status that day and will probably depend on when you do the test compared to when you took the supplement. The body doesn’t store zinc so it’s not possible to build up levels like it is with iron, for example. I do occasionally test for zinc but I’m starting to just give a daily dose according to symptoms.

        • All that said, a liquid is usually better absorbed and you could think about whether your zinc absorption is being impaired by gluten or dysbiosis. The Pill is another cause of poor zinc absorption but I assume that’s not your situation.

  19. I have been diagnosed with both PCOS and adenomyosis. How ever I have not found any trustworthy information on adenomyosis and what I can do to help deal with it. When I had an operation to sort out my “issues” the diagnosis was given to me while coming out of anaesthetic and that was it. Have you written more about this problem or can you please direct me to a reliable source. Thank you, I really enjoy your blog.

    • I discuss adenomyosis in Chapter 9 of my new book. It has similarities to another condition called endometriosis and the treatment is similar. I also hope to write a blog post about it soon.

  20. Is there a place we can all go to suggest /petition a name change?

    It seems like the name alone can cause misunderstanding, misdiagnosis and further trouble for these poor women suffering.

    • A new name is coming. One of the proposed names is “anovulatory androgen excess.” Maybe AAE for short?

      And yes, it will be SO good to shift the focus from the ovaries and the ultrasound finding.

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